Primary Care


Joslyn Levy & Associates

Funding Area

Primary Care


August 6, 2014


This NYHealth-funded report, prepared by Joslyn Levy & Associates, examines some approaches in New York State to expand and improve care management for health home members—patients who have multiple chronic conditions and intensive, high-cost service needs.

The health home model provides the basis for unified systems of care to coordinate and integrate physical and behavioral health care, chemical dependence treatment, and social services provided to its members. Partnerships between health care organizations and social service and behavioral health agencies are an essential part of the model. New York health homes’ experience to date offers early lessons and promising practices to achieve a comprehensive care management model.

The report examines how New York health homes are working to innovate, collaborate, test, and refine care management strategies. It identifies nine topics that impact the design and delivery of care management in health homes, including the health home network structure, staff member training, caseload balance, and collaboration with care providers. Specifically, the report:

  • Presents a broad overview of the many aspects of health homes that influence how care management is designed and delivered within those settings;
  • Identifies common challenges to care management in New York State health homes;
  • Highlights promising practices in care management alongside variation in strategies and models across health homes; and
  • Identifies issues that warrant more in-depth exploration to inform the field.